After an unplanned pregnancy, a Durango woman wanted her fiancé to get a vasectomy at Durango Family Medicine, but scheduling became impossible when Mercy Regional Medical Center acquired the physicians’ practice last summer.

Sterilizations, as well as the placement of intrauterine devices for birth control, were discontinued as of Aug. 1 because the procedures conflict with Catholic religious and ethical directives, said David Bruzzese, spokesman for Centura Health, the Englewood-based network that bought Mercy in 2010.

The couple could have gone to another urologist not affiliated with the Catholic hospital but would have paid $300 more for a total bill of nearly $1,000. Also, the doctor performs the outpatient surgeries only on Thursday mornings.

The Durango woman, who asked that her name not be used because of the sensitivity of the subject, appreciates that health-care mergers have become necessary in these hard economic times. But she is disturbed that the community is losing access to reproductive care, and no one seems to be speaking out.

Mercy also is phasing out Durango Family Medicine’s obstetrics services with the last of the patients who started their prenatal care before the acquisition in August.

“Obstetric services are provided by others in the community, and we determined that it would be best for the practice to focus solely on primary-care services,” Bruzzese said.

The Durango woman, who also works in the health-care industry, sees problems with Mercy’s position.

“It’s really conflicting for the hospital to not allow certain forms of birth control but then not provide prenatal care. It’s kind of like they’re causing a problem and then making it worse,” the woman said.

Durango Family Medicine is the second local provider to drop prenatal-care services since San Juan Basin Health Department discontinued its prenatal services a year ago. San Juan cited low Medicaid reimbursements as the reason.

Southwest Midwives and Four Corners Obstetrics and Gynecology are the remaining providers of prenatal care. Three certified home-birth midwives in town also provide prenatal care. Bruzzese said Mercy determined that these providers would have adequate capacity to pick up the demand.

“No one is standing in line,” he said.

Mercy, which is celebrating its 130th anniversary this year, has always made its mission providing affordable care to Durango, Bruzzese said. Last year, it was not compensated for $22 million worth of services.

It has not set out to monopolize local health-care services but rather has responded to offers from providers who preferred to become employees of Mercy rather than operate their own businesses, Bruzzese said.

Mercy, for example, has taken over clinics to ensure continuity of vital services.

“Mercy wants nothing but to increase access to health care,” he said.

The hospital always has taken a collaborative approach, he said. If it cannot provide service, it will direct patients to other providers in the community.

Increase in patients

Sheila Reynertson, advocacy coordinator for MergerWatch, said consolidations resulting in the loss of community access to health care has become a trend across the United States.

“It’s frustrating for the community. It’s frustrating for the providers who must take on the influx of patients,” Reynertson said. “If there’s only one hospital in town, it’s difficult (for providers) to speak out publicly.”

MergerWatch is a national advocacy group that tracks mergers involving religious health-care providers.

Gail Murphy, practice manager for Four Corners Obstetrics and Gynecology, said it has seen an increase in patients but was prepared because it knew about the changes at Durango Family Medicine and San Juan Basin.

Murphy said Four Corners does not have plans to change its business model or merge with Mercy. The practice offers a full range of obstetrical and gynecological care, including contraception, in-office tubal ligations, IUD insertions, and counseling and prescribing for all methods of family planning, Murphy said.

La Plata County and its neighboring counties are considered by the Colorado Department of Health and Environment to be at a shortage for physicians, although not as severe as the state’s Eastern Plains.

Stephen Holloway, director of equity and access for the state health department, said La Plata County easily could support another obstetrician/gynecologist and that the region could use three more primary-care physicians. The estimates are based on the ratio of one physician for 3,000 people.

Insufficient prenatal care is cited as a contributing factor for low birth weight, which in turn contributes to infant morbidity and impairs normal childhood development.

La Plata County has had a higher-than-average incidence of low birth weight – about 9 percent of births compared to the national average of 6 percent, according to data published by the Citizens Health Advisory Council. That was in 2010, when La Plata County had the four prenatal care providers.

What Rome doesn’t know

There already is much confusion about what services Mercy provides or doesn’t.

Pro-life advocates have picketed outside the hospital even though abortions are not performed on the property.

Four Corners OB/GYN provides certain family-planning services at odds with Catholic ethical directives, but Four Corners is a private practice located in the hospital’s office wing, the Mercy Medical Plaza, which is not actually owned by the hospital.

Several health-care providers who did not want to be identified said tubal ligations, a sterilization procedure, are performed in the hospital’s operating rooms after a delivery by Caesarean section, but local physicians say they are not supposed to acknowledge these sterilization procedures publicly.

The understanding is that “Rome is not supposed to know what’s happening in Durango,” said a source knowledgeable about local health care who spoke on condition of anonymity.

Bruzzese denied the suggestion that there is a gag order. He said each case is looked at individually. Sometimes, operations do result in sterilizations, he said.

Another source knowledgeable about procedures at the hospital said Mercy will allow sterilizations and certain birth-control services if they can be justified for reasons other than birth control, such as a treatment for heavy menstrual bleeding.

Tubal ligations after C-sections are justified because another pregnancy would be dangerous to the mother’s and fetus’ health.

But a man wanting to remove a hernia from his groin, however, cannot get a vasectomy performed at the same time at Mercy, even though the hernia operation carries a risk for accidental sterilization anyway, said a local general surgeon who asked not to be identified.

Resistance to mergers

As health-care mergers have proliferated across the country, community activists have spoken out against the loss of community access to reproductive care.

Kentucky Gov. Steve Beshear, for example, rejected the merger of Catholic and public hospitals in Louisville because it would have resulted in a loss of community access to certain kinds of reproductive and end-of-life care.

In 2010, a coalition of activists in rural Arizona prevented a local hospital from merging with an out-of-state Catholic health-care system that also would have resulted in the loss of reproductive care, according to a The New York Times report.

Colorado’s laws about mergers are not as robust as other states, said Reynertson of MergerWatch. There is no opportunity, for example, for a public hearing when a health-care service is about to be lost or curtailed because of a business merger or acquisition.

Colorado health officials said the state cannot regulate the free market or mandate what types of service providers must perform.

While San Juan Basin Health Department has been politically active in advocating a smoking ban, it does not consider it part of its policy or health strategy to speak out on the issue of community access to reproductive services, said Joe Theine, director of the department.

Instead, the department concentrates on providing birth control on a sliding scale to low-income patients.

While low Medicaid reimbursements for prenatal care and obstetrics often is why health-care providers stop providing those services, Medicaid reimbursement rates are supposed to increase in 2014 under the Affordable Health care Act.

Theine said he could not speculate about whether that would prompt San Juan Basin Health Department to bring back prenatal care.